E.V.I.dently September 2016
Considering Value in Health Care
Our health care system is in a period of great transformation, thanks to significant advances in medical therapies, as well as data and technology and how we deliver health care to patients. But with change comes uncertainty, and questions: how do we value all of these advances and ensure their positive impact on patient health and our health care system? In a Chain Drug Review commentary, NPC President Dan Leonard explains how to help decision-makers identify the true value of health care.
NPC News & Research
Last Chance to Register for Assessing Value: Promise & Pitfalls (Online Option Available!)
There’s still time to register to join us live online for Assessing Value: Promise & Pitfalls on Thursday, Sept. 29, 2016. During the conference, we will share research that evaluates how existing frameworks align with NPC’s Guiding Practices for Patient-Centered Value Assessment and explore the variable outputs from multiple myeloma treatment assessments conducted using four different frameworks. A broad range of stakeholders will share their perspectives on the research, uncovering the lessons learned to date and how best to advance the field of value assessment.
We’re at capacity for onsite participation, but we encourage you to watch the conference live online. Register online now to join us!
NPC Submits Comments to Improve the ICER Framework
On September 12, NPC submitted public comments to the Institute for Clinical and Economic Review (ICER) about ways to improve its value assessment framework. As NPC has noted, value assessments are a new and evolving field, and potentially can have a tremendous impact on patient access to needed and innovative treatments. Given that the field is in its infancy, more work remains to be done before ICER—or other frameworks—are ready for widespread adoption and use by stakeholders. Since one framework cannot meet the needs of all stakeholders, we look forward to continuing to have constructive dialogues with all developers to evolve value frameworks in a thoughtful, inclusive and patient-centered way.
Three Ways to Reduce Low-Value Care for Patients
In 2013, there was an estimated $765 billion in wasted health care expenditures due to low-value care, which shows that work still needs to be done to reduce its impact on our overall health care system. NPC, the Altarum Institute and the University of Michigan Center for Value-Based Insurance Design co-authored a study published on the Health Affairs blog to shed light on the importance of reducing low-value health care in the United States. The authors pointed out that identifying wasteful or unnecessary medical tests, treatments and procedures has allowed physicians to make better decisions on a patient’s care plan based on their unique situation and contributed to a reduction in the cost of care. The also identified three areas where that consensus exists on defining and measuring other areas of low-value care to begin further efforts to reduce it and improve quality and lower costs.
Optimizing the recipe for ‘health care spending pie’: Finding the most effective resource allocation
As health care costs continue to climb, rising 5.3 percent in 2015 and approaching 18 percent of the U.S. economy, it is more essential than ever to ensure patients receive appropriate care quickly and efficiently. Unfortunately, the Institute of Medicine estimates that approximately 30 percent of health care spending could be avoided – and a significant portion of that stems from unnecessary services. Despite concerns about the growth of the health care pie, little attention has been paid to the spending upon slices within it. NPC Chief Science Officer and Executive Vice President Robert Dubois, MD, PhD, explored questions about spending and care value in his latest “Methods to Policy” column in the Journal of Comparative Effectiveness Research, and found that using traditional research methods to find the answers may not suffice.
Comparative Effectiveness Research & Related News
FDA to Hold Public Hearing on Manufacturer Communications
Because the biopharmaceutical industry is highly regulated, there are many questions and uncertainty about which information used in health care decision-making is permissible to share. NPC research and educational events have highlighted the importance for all stakeholders, including the biopharmaceutical industry, to be able to discuss health care information used in health care decision-making, respond to research and ultimately improve public health. Given this uncertainty, the Food and Drug Administration (FDA) announced that it will hold a public hearing on November 9-10, 2016, and seek stakeholder feedback on “FDA’s regulation of firms’ communications about medical products, with a particular focus on firms’ communications about unapproved uses of their approved/cleared medical products."
AMCP Brings Stakeholders Together to Seek Solutions for ‘Enabling the Exchange of Clinical and Economic Data Pre-Approval’
On September 13-14, the Academy of Managed Care Pharmacy hosted a partnership forum, “Enabling the Exchange of Clinical and Economic Data Pre-Approval,” focused on ways to modernize existing regulations so that biopharmaceutical manufacturers could provide clinical and economic information related to medications and health care technologies to payers and other entities at least 12-18 months prior to Food and Drug Administration approval. NPC VP for Comparative Effectiveness Research Jennifer Graff, PharmD, participated in the discussion. The proceedings document is scheduled to be published in the December 2016 issue of the Journal of Managed Care & Specialty Pharmacy.
ICYMI: Articles of Interest
- Armstrong, P; McAlister, F. Searching for Adherence: Can We Fulfill the Promise of Evidence-Based Medicines? Journal of the American College of Cardiology. August 2016.
- Mafi, J; et al. Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians. Annals of Internal Medicine. August 16, 2016.
- Song, Z; Fisher, E. Viewpoint: The ACO Experiment in Infancy—Looking Back and Looking Forward. JAMA. August 16, 2016.
- Kazi, D.; et al. Cost-Effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease. JAMA. August 16, 2016.
- Lakdawalla, D.; Neumann, P. Budget Criteria And Drug Value Assessments: A Case Of Apples And Oranges? Health Affairs Blog. September 22, 2016.
- Sanders, G; Neuman, P; Basu, A; et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. September 13, 2016.
Health & Productivity
Exploring ‘Dynamic’ Cost-Sharing Models in Value-Based Insurance Design
This new paper, supported by NPC and written by Dr. Mark Fendrick of the Value-Based Insurance Design Center at the University of Michigan, examines how to align consumer cost-sharing with the clinical value of a treatment. Currently, patients whose personal biology necessitates “higher tier” treatment may face longer timelines and/or higher out-of-pocket costs to receive the treatment they need. Dr. Fendrick’s dynamic pricing proposal explores options to reward patients who follow care as dictated by their physicians, as opposed to the existing static tier system that often requires patients to pay more out of pocket for the higher-tier treatment their individual circumstances may require.
- September 29: Assessing Value: Promise & Pitfalls – Register now to attend NPC’s upcoming conference about value assessment frameworks. We’re at capacity for onsite participation, but we encourage you to watch the conference live online. Keep track of the event on social media by following NPC (@npcnow) on Twitter and using the hashtag #npcvalueconf.
- October 3-6: AMCP 2016 Nexus – The Academy of Managed Care Pharmacy hosts its annual Nexus conference next month to “provide managed care pharmacy professionals with profound insights and powerful tools to find solutions for some of the toughest problems they face.” The agenda includes a presentation by NPC Vice President for Health Services Research Kimberly Westrich and Director of Research Michael Ciarametaro examining value framework assessment tools. Additionally, this conference will provide an opportunity for participants in the CER Collaborative Certificate course to participate in an interactive peer workshop and complete their training.